Anticholinergic medications are prescribed by mental health clinicians to treat (or prevent) some extrapyramidal side effects of antipsychotic medications—acute dystonia and parkinsonism.
Note: It is very important for us to know that anticholinergic medications do NOT work for akathisia or tardive dyskinesia. In fact, they may make tardive dyskinesia worse.
Oral anticholinergic medications
Tablets
The anticholinergic medications most commonly used, in the US and elsewhere, are:
1. Benztropine (0.5 mg, 1 mg, and 2 mg tablets).
Generic only; it was previously available as brand-name Cogentin®)
2. Trihexyphenidyl (2 mg and 5 mg tablets).
Generic only; it was previously available as the brand name Artane®)
Anticholinergic medications that are used in Europe but are no longer available in the United States are:
1. Biperiden: Biperiden is no longer available in the United States. It is available in Europe under the brand name Akineton®.
2. Procyclidine: Procyclidine is no longer available in the United States. It is available in Europe under the brand name Kemadrin®.
An antihistamine that is often used for its anticholinergic properties:
Diphenhydramine: (25 mg tablets or capsules)
Generic and brand name (Benadryl®).
Diphenhydramine is not simply an anticholinergic medication. It is an antihistamine that also has anticholinergic activity. But it is included here because it is often used to treat extrapyramidal side effects of antipsychotics.
Oral solutions
Trihexyphenidyl oral solution (generic, 2 mg/5mL)
Injectable anticholinergic medications
Benztropine 2mg/2mL (ampule or vial)
Next, for clinically important differences between the available anticholinergic medications and tips on prescribing them, please see the following article on this website:
Clinically important differences between the available anticholinergic medications
Related Pages
Anticholinergic Medications
Should we routinely prescribe an anticholinergic with an antipsychotic?
Anticholinergic medications prescribed by mental health clinicians: Menu of options
Clinically important differences between anticholinergic medications
For how long should anticholinergics be given for antipsychotic-induced parkinsonism?
After a few months, try to reduce/ stop anticholinergic medication
How does toxicity from anticholinergic medications present clinically?
Cholinergic rebound syndrome: Why we should NOT stop anticholinergic medications abruptly
An anticholinergic medication for antidepressant discontinuation (withdrawal)?
Topical anticholinergics for localized hyperhidrosis
Side Effects—Parkinsonism—Clinical features and causes
Antipsychotic-induced parkinsonism clinical features
Is lumateperone less likely to cause extrapyramidal symptoms (including parkinsonism or akathisia)?
Medication-induced tremors: An overview
How to examine a person with tremors
Tips on differentiating between antipsychotic-induced parkinsonism and Parkinson’s disease
What we know about VMAT2-inhibitor-induced parkinsonism
Can valproate cause parkinsonism?
Can buspirone cause dyskinesia or parkinsonism?
Can lithium cause parkinsonism?
Side Effects—Parkinsonism—Prevention and Management
Can we prevent neuroleptic-induced parkinsonism?
Tips on treating antipsychotic-induced parkinsonism
Does dose reduction work for neuroleptic-induced parkinsonism?
Anticholinergic medications in mental health: Menu of options
Clinically important differences between anticholinergic medications
For how long should anticholinergics be given for antipsychotic-induced parkinsonism?
Amantadine for antipsychotic-induced parkinsonism
Amantadine (Symmetrel): Basic information
Side Effects: Main menu (index and links)
References
Ghossein N, Kang M, Lakhkar AD. Anticholinergic Medications. 2023 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32310353.
Vanegas-Arroyave N, Caroff SN, Citrome L, Crasta J, McIntyre RS, Meyer JM, Patel A, Smith JM, Farahmand K, Manahan R, Lundt L, Cicero SA. An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders. CNS Drugs. 2024 Apr;38(4):239-254. doi: 10.1007/s40263-024-01078-z. Epub 2024 Mar 19. PMID: 38502289; PMCID: PMC10980662.
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